Thank you for your time and this very valuable
gift. Your comments are extremely important to us.
Please be as candid and brutually honest as you can
about your most recent experience with us. Your comments
and feedback help us to continuously improve and
hopefully continue to earn your business and your
loyalty. (Your referrals are critically important
to our success). If we really messed up, please allow
us an opportunity to call you personally to apologize.
Upon submission, please check your email or spam
folder for a message from us along with a small token
of appreciation for your time and comments.

In as much detail as you care to provide, please tell us
what we did right, what we did wrong and any suggestions
you would be willing to share with us about how we can
improve to better serve you.

1.

How
likely is it that you would recommend Tri-Valley Pharmacy to
friends and colleagues?

1
2
3
4
5
6
7
8
9
10

Not
Likely

Very
Likely

2.

What,
specifically, would you tell someone to get
them to try Tri-Valley Pharmacy?

3.

What
would it take for you to rank Tri-Valley Pharmacy a
10?

4.

What
is the reason or reasons for your score?

5.

How
is your experience with Tri-Valley Pharmacy different
than other similar pharmacies?

6.

Please
let us know the name of any particular member
of our team that impacted your rating of
us. Please feel free to provide any details.

7.

We
are terribly sorry that your experience was
far below our standards. We would appreciate
the opportunity to apologize and try to make
it up to you. If you would allow us the opportunity
to do so, please provide your name, telephone
number, and best time of day for us to contact
you.

First

Last

Name:

Phone
Number:

[ie. 123-456-7890]

Best
Time to Call:

So that we can send a small expression
of our gratitude for your valuable time and comments,
please provide your Email Address.

2.

Email
Address:

(We hate spam and
promise to never share your information with
anyone.)

3.

May we include you on
our Healthy Home monthly newsletter and medical
alert list? Yes
No